Around 30% of Bilateral High Myopic Patients Will Develop Fellow-Eye Macular Neovascularization

Fine and irregular yellow lines in and around the macula are typical features of lacquer cracks (shown here in ICGA imaging) and may represent healed scars of breaks in the RPE-Bruch’s membrane-choriocapillaris complex and are unlikely to trigger mMNV.  Photo: Lim SH, et al.Acta Ophthalmol. August 5, 2025. Click image to enlarge.  Nearsightedness can be an annoyance, but once it crosses a threshold and becomes high myopia, these patients become more at risk for a host of serious ocular complications or conditions, including myopic macular neovascularization (mMNV). Incidence of mMNV has been reported, but research on developing the condition in uninvolved fellow eyes in patients with preexisting mMNV is limited. As such, researchers wanted to better understand clinical features and treatment outcomes of bilateral mMNV cases.In a paper published in Acta Ophthalmologica, Korean researchers retrospectively examined patients with bilateral high myopia who were newly diagnosed with unilateral mMNV. After recorded follow-up of >36 months, patients were classified into either unilateral or bilateral groups, based on if the second uninvolved eye also developed mMNV.The total number of patients was 93, with a mean age of 55.4 years and 76.3% being female. Mean baseline spherical equivalent was -13.0D. Of all participants, 22.6% developed mMNV in the second eye during a mean follow-up period of 95.1 months, with cumulative probabilities of development in the second eye of 16.2% at five years and 28.9% at 10 years. In the unilateral group, the second, uninvolved eye had shorter axial length and greater subfoveal choroidal thickness than mMNV eyes. What’s more, the unilateral group also showed greater interocular difference in axial length than the bilateral group.Interestingly, the only significant risk factor for second eye mMNV development was lacquer crack presence, with a hazard ratio of 5.6. The bilateral group had the second eye experience less vision improvement after anti-VEGF treatment; however, final visual acuity and cumulative probability of fovea-involving mMNV-related chorioretinal atrophy did not differ between the eyes.While pathogenesis of mMNV is not fully understood, multiple explanations have been proposed, including a basis in mechanical, vascular, systemic and genetic etiologies. Lacquer cracks, though, are already well-known as predisposing lesions of developing mMNV. This is due to them being thought of as representative mechanical breaks in the complex of the retinal pigment epithelium-Bruch’s membrane-choriocapillaris as a result of elongation in highly myopic eyes.The lacquer cracks being the only risk factor in developing fellow eye mMNV indicates a mechanical factor in its development, but this may not indicate that new mMNV development happens at the preexisting crack. Instead, the mMNV may develop through a relatively new break that isn’t healed yet or during the healing process. As the authors of the study elaborate, “as a risk factor for mMNV, a preexisting lacquer crack in the second eye may simply imply persistent expansional stress at the posterior pole due to continuous axial elongation or staphyloma enlargement, which may lead to the formation of new breaks and eventually result in mMNV development.”Due to this association, the authors support that lacquer crack presence “should raise caution during follow-up to enable early detection and timely intervention” in unilateral mMNV patients.  Click here for the journal source. Lim SH, Bae K, Yoon CK, et al. Clinical characteristics and treatment outcomes of bilateral myopia macular neovascularization in high myopic patients. Acta Ophthalmol. August 5, 2025. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.